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Adequate P2Y12 Inhibition and Thrombocytopenia after Transcatheter Aortic Valve Replacement [Meeting Abstract]

Ibrahim, Homam; Vapheas, Eleonora; Jilaihawi, Hasan; Staniloae, Cezar; Shah, Binita; Williams, Mathew
ISI:000413459200575
ISSN: 1558-3597
CID: 2802552

Aorto-Right Ventricular Fistula Post-Transcatheter Aortic Valve Replacement: Multimodality Imaging of Successful Percutaneous Closure

Vainrib, Alan F; Ibrahim, Homam; Hisamoto, Kazuhiro; Staniloae, Cezar S; Jilaihawi, Hasan; Benenstein, Ricardo J; Latson, Larry; Williams, Mathew R; Saric, Muhamed
PMCID:6034486
PMID: 30062248
ISSN: 2468-6441
CID: 3217032

SHORT- AND MID-TERM OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH RENAL INSUFFICIENCY NOT ON HEMODIALYSIS [Meeting Abstract]

Paone, Darien; Shah, Binita; McDonald, Daniel; Thakker, Rahul; Houanche, Pascale; Neuburger, Peter; Saric, Muhamed; Staniloae, Cezar; Jilaihawi, Hasan; Querijero, Michael; Williams, Mathew
ISI:000397342301736
ISSN: 1558-3597
CID: 2528912

Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease

Teperman, Jacob; Carruthers, David; Guo, Yu; Barnett, Mallory P; Harris, Adam A; Sedlis, Steven P; Pillinger, Michael; Babaev, Anvar; Staniloae, Cezar; Attubato, Michael; Shah, Binita
BACKGROUND: The aim of this study was to determine the association between neutrophil-lymphocyte ratio (NLR) and severity of lower extremity peripheral artery disease (PAD). METHODS: A retrospective chart review identified 928 patients referred for peripheral angiography. NLR was assessed from routine pre-procedural hemograms with automated differentials and available in 733 patients. Outcomes of interest were extent of disease on peripheral angiography and target vessel revascularization. Median follow-up was 10.4months. Odds ratio (OR) [95% confidence intervals] was assessed using a logistic regression model. RESULTS: There was a significant association between elevated NLR and presence of severe multi-level PAD versus isolated suprapopliteal or isolated infrapopliteal disease (OR 1.11 [1.03-1.19], p=0.007). This association remained significant even after adjustment for age (OR 1.09 [1.01-1.17], p=0.02); age, sex, race, and body mass index (OR 1.08 [1.00-1.16], p=0.046); and age, sex, race, body mass index, hypertension, diabetes mellitus, coronary artery disease, and creatinine (OR 1.07 [1.00-1.15], p=0.049). After additional adjustment for clinical presentation, there was a trend towards association between NLR and severe multi-level PAD (OR 1.07 [1.00-1.15], p=0.056), likely limited by sample size. In patients who underwent endovascular intervention (n=523), there was no significant difference in rate of target vessel revascularization across tertiles of NLR (1st tertile 14.8%, 2nd tertile 14.1%, 3rd tertile 20.1%; p=0.32). CONCLUSION: In a contemporary cohort of patients undergoing peripheral angiography with possible endovascular intervention, elevated NLR was independently associated with severe multi-level PAD. Larger studies evaluating the association between this inexpensive biomarker and clinical outcomes are warranted.
PMID: 27865186
ISSN: 1874-1754
CID: 2311112

Alterations of Blood Flow Through Arteries Following Atherectomy and the Impact on Pressure Variation and Velocity

Plourde, Brian D; Vallez, Lauren J; Sun, Biyuan; Nelson-Cheeseman, Brittany B; Abraham, John P; Staniloae, Cezar S
Simulations were made of the pressure and velocity fields throughout an artery before and after removal of plaque using orbital atherectomy plus adjunctive balloon angioplasty or stenting. The calculations were carried out with an unsteady computational fluid dynamic solver that allows the fluid to naturally transition to turbulence. The results of the atherectomy procedure leads to an increased flow through the stenotic zone with a coincident decrease in pressure drop across the stenosis. The measured effect of atherectomy and adjunctive treatment showed decrease the systolic pressure drop by a factor of 2.3. Waveforms obtained from a measurements were input into a numerical simulation of blood flow through geometry obtained from medical imaging. From the numerical simulations, a detailed investigation of the sources of pressure loss was obtained. It is found that the major sources of pressure drop are related to the acceleration of blood through heavily occluded cross sections and the imperfect flow recovery downstream. This finding suggests that targeting only the most occluded parts of a stenosis would benefit the hemodynamics. The calculated change in systolic pressure drop through the lesion was a factor of 2.4, in excellent agreement with the measured improvement. The systolic and cardiac-cycle-average pressure results were compared with measurements made in a multi-patient study treated with orbital atherectomy and adjunctive treatment. The agreements between the measured and calculated systolic pressure drop before and after the treatment were within 3%. This excellent agreement adds further confidence to the results. This research demonstrates the use of orbital atherectomy to facilitate balloon expansion to restore blood flow and how pressure measurements can be utilized to optimize revascularization of occluded peripheral vessels.
PMID: 27333887
ISSN: 1869-4098
CID: 2220852

Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure

Shah, Binita; Burdowski, Joseph; Guo, Yu; Velez de Villa, Bryan; Huynh, Andrew; Farid, Meena; Maini, Mansi; Serrano-Gomez, Claudia; Staniloae, Cezar; Feit, Frederick; Attubato, Michael J; Slater, James; Coppola, John
Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (>/=3 of 4 following criteria: age >/=70 years, female gender, height
PMCID:4976048
PMID: 27328954
ISSN: 1879-1913
CID: 2159122

Relationship between neutrophil-lymphocyte ratio and severity of lower extremity peripheral artery disease in patients undergoing peripheral angiography [Meeting Abstract]

Teperman, J; Barnett, M P; Carruthers, D; Pillinger, M; Sedlis, S P; Babaev, A; Attubato, M; Staniloae, C S; Shah, B
Background: Unlike for coronary artery disease, the association between neutrophil-lymphocyte ratio (NLR) and peripheral artery disease (PAD) has not been well established. The aim of this study was to determine the association between neutrophil-lymphocyte ratio and the severity of lower extremity peripheral artery disease. Methods: A retrospective chart review analysis identified 928 patients referred for peripheral angiography at a tertiary care center between December 2012 and June 2015. NLR was assessed from routine pre-procedural hemograms with automated differentials and available in 733 (79%) patients. Outcomes of interest included extent of disease on peripheral angiography and target vessel revascularization. Median follow-up was 10.4 months. Odds ratio (OR) [95% confidence intervals] was assessed using a logistic regression model. Results: There was a significant association between elevated NLR and the presence of severe multi-level PAD versus isolated suprapopliteal or isolated infrapopliteal disease (OR 1.42 [1.18-1.70], p=<0.001). This association between NLR and severe multi-level PAD remained significant even after adjustment for age (OR 1.31 [1.09-1.58], p=0.004); age, sex, race, and body mass index (OR 1.27 [1.05-1.5], p=0.015); and age, sex, race, body mass index, hypertension, diabetes, coronary artery disease, and creatinine (OR 1.25 [1.03-1.53], p=0.024). In patients who underwent endovascular intervention (n=523), there was no significant difference in the rate of target vessel revascularization on follow-up across tertiles of NLR (1st tertile 14.8%, 2nd tertile 14.1%, 3rd tertile 20.1%; p= 0.32). Conclusion: In a contemporary cohort of patients undergoing peripheral angiography with possible endovascular intervention, elevated NLR was independently associated with severe multi-level PAD
EMBASE:72281982
ISSN: 1522-726x
CID: 2151582

Physiologic Guidance of Infrainguinal Vascular Interventions Using the Pressure Wire

Staniloae, Cezar S; Vales, Lori; Han, Seol Young; Sloves, Jan; Fallahi, Arzhang
OBJECTIVES: To assess the relationship between the resting (RG) and hyperemic (HG) translesional peripheral gradients, with the functional and anatomic parameters before and after an infrainguinal endovascular procedure. BACKGROUND: RGs and HGs are objective tools in defining the hemodynamic significance of an arterial stenosis. METHODS: In 25 subjects with infrainguinal arterial stenosis, RG and HG were measured via a pressure wire before and after angioplasty. Before and after the procedure, all subjects had an ankle-brachial index (ABI) and Duplex ultrasound evaluation, recording prelesion and in-lesion peak systolic velocity (PSV-L), and calculating a peak systolic velocity ratio (PSV-R). A Pearson R correlation coefficient was calculated. RESULTS: The mean age was 73 +/- 12 years, 70% were men, median Rutherford class 3. At baseline and after angioplasty, mean ABI was 0.78 +/- 0.2 and 0.99 +/- 0.1, mean PSV-L was 459 +/- 110 cm/s and 126 +/- 35 cm/s, and mean PSV-R was 6.7 +/- 4 and 1.2 +/- 0.5, respectively. RG and HG significantly improved (P<.001) from baseline to after angioplasty (28.7 +/- 20.5 mm Hg to 5 +/- 13 mm Hg and 40.2 +/- 21.4 mm Hg to 10 +/- 13 mm Hg, respectively). RG before and after the procedure correlated well with ABI (r = -0.58; r = -0.41), PSV-L (r = 0.40; r = 0.52), and PSV-R (r = 0.46; r = 0.42). An improvement of 9 mm Hg in RG predicted a change of 0.1 in ABI. CONCLUSIONS: Improvement in RG during endovascular intervention in superficial femoral artery correlates well with the improvement in ABI, PSV-L, and PSV-R. A postprocedural decrease in RG of 9 mm HG predicts an improvement in ABI of 0.1.
PMID: 26429850
ISSN: 1557-2501
CID: 1790022

Implementation of a moderate sedation protocol for transfemoral transcatheter aortic valve replacement: A review at 6 months [Meeting Abstract]

Neuburger, P; Potosky, R; Ursomanno, P; Abdallah, R; Saric, M; Benenstein, R J; Staniloae, C S; Slater, J; Querijero, M; Williams, M
BACKGROUND Transfemoral transcatheter aortic valve replacement (TF TAVR) can be performed under general anesthesia (GA) or moderate sedation (MS). Despite observational studies suggesting a shorter length of stay (LOS), shorter procedural time and a similar mortality rate with MS, only 5% of patients undergoing TF TAVR in the United States are done with this type of anesthesia. We reviewed the implementation of a MS for TF TAVR protocol at a single institution with no previous experience with this technique. METHODS Patients with severe obstructive sleep apnea (OSA), likely difficult intubation, inability to tolerate supine position due to musculoskeletal disease, or barriers to communication including altered mental status were performed under GA with intraoperative transesophageal echocardiography. All others received MS with an ilioinguinal nerve block and intraoperative transthoracic echocardiography. The MS for TF TAVR protocol was implemented on October 9th, 2014. The records of patients undergoing TF TAVR 6 months before and after protocol implementation were retrospectively reviewed. RESULTS In the pre protocol group 33 patients underwent TF TAVR under GA and no patients received MS. In the post protocol group, 97 underwent TF TAVR, 81 (83.5%) of which received MS. OSA was the most common reason for GA (N=10, 62.5%). Conversion from MS to GA occurred in 2 cases (2.5%) due to procedural complications, of which 1 resulted in death. All other cases involving MS were tolerated well and there were no anesthesia related complications. Post procedural LOS (3.2 days vs. 5.0 days, p=0.002) and procedure time (144.0 minutes vs. 96.1 minutes, p<0.001) were both significantly shorter in post protocol group. The post protocol group was also significantly less likely to require a skilled nursing facility upon discharge (24.2% vs. 8.2%, p=0.027). In hospital mortality was similar between groups (N=2 6.1% vs. N=3, 3.1%, p=0.601). (Table Presented) CONCLUSIONS The MS for TF TAVR protocol appears safe and can be rapidly implemented at institutions with no previous MS experience. This technique is feasible in the majority of patient undergoing TF TAVR. Post procedural LOS and procedural time are multifactorial, but this data further suggests MS may be beneficial in select patients
EMBASE:72065352
ISSN: 0735-1097
CID: 1841642

Effect of left versus right radial artery approach to coronary angiography on radiation exposure in patients with predictors of transradial artery access failure [Meeting Abstract]

Shah, Binita; Burdowski, Joseph; Guo, Yu; de Villa, Bryan Velez; Huynh, Andrew; Farid, Meena; Maini, Mansi; Serrano-Gomez, Claudia; Fallahi, Arzhang; Staniloae, Cezar S; Attubato, Michael; Feit, Frederick; Slater, James; Coppola, John
ISI:000363329000373
ISSN: 1558-3597
CID: 1830572